Provider Demographics
NPI:1992126122
Name:COWLING, CHESTLEY THOMAS JR
Entity type:Individual
Prefix:MR
First Name:CHESTLEY
Middle Name:THOMAS
Last Name:COWLING
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MARINA CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3402
Mailing Address - Country:US
Mailing Address - Phone:757-618-4064
Mailing Address - Fax:
Practice Address - Street 1:206 MARINA CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3402
Practice Address - Country:US
Practice Address - Phone:757-618-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46-4275395171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA46-4275395OtherEIN